Coronary Artery Aneurysms: Evolving Trends in Surgical Management

To evaluate temporal trends and evolution of surgical techniques for coronary artery aneurysms.

From 1/2006 to 1/2025, 146 patients (age 63±13 years; 37[25%] female) with 172 coronary aneurysms underwent coronary surgery at Cleveland Clinic. Indications, operative trends, and outcomes were analyzed. Patients fell into 2 groups: the addressed(N=85), when the aneurysm was a direct or indirect indication for surgery, or the unaddressed(N=61) in which it was not.

Operative indications in the addressed group were size (58[68%]), aneurysm-related coronary ischemia (55[65%]), shunting (27[32%]), concomitant coronary artery disease (22[26%]), and infection (4[4.7%]). In the unaddressed group, coronary ischemia due to coronary artery disease was the sole indication. Patients in the addressed group underwent ≥1 of the following: coronary artery bypass grafting (CABG) (60[71%]), (14[16%] CABG alone), excision/ligation (34[40%]), fistula ligation (31[36%]), in-situ graft-based reconstruction (19[22%]), and direct repair (9[11%]). More comprehensive aneurysm-directed repairs, including graft-based reconstruction, increased over time. All unaddressed patients underwent CABG alone. Operative mortality was 2.4% and 3.4% for the addressed and unaddressed groups, respectively. Five- and 10-year survival was 80% and 63% in the addressed group versus 63% and 48% in the unaddressed group. Survival in both groups was similar to our institutional age- and sex-matched CABG cohorts (addressed log-rank P=.67; unaddressed log-rank P=.45).

Surgical management of coronary artery aneurysms has evolved toward more complex aneurysm-directed reconstructions. When indicated by aneurysm size, ischemia, shunting, infection, or symptoms, surgical repair can be performed without added risk, with long-term survival comparable to the general CABG population.